Cannabinoid hyperemesis syndrome is characterized by chronic, heavy use of cannabis, recurrent episodes of severe nausea and intractable vomiting, and abdominal pain. Temporary relief of symptoms is achieved by taking a hot bath or shower, and resolution of the problem when cannabis use is stopped. Failure to recognize the syndrome leads to misdiagnoses such as psychogenic vomiting, the cyclic vomiting syndrome, an eating disorder or ‘drug-seeking behaviour’, and may lead to extensive, expensive and unproductive investigations, psychiatric referrals and ineffective treatments. Other than stopping cannabis use, there is no proven treatment. Why a substance known for its antiemetic properties should cause such a syndrome is unknown.

I was asked to see a young man who had numerous visits to the emergency department for episodes of abdominal pain and intractable vomiting. The working diagnosis was pancreatitis because he often had a mild elevation in amylase. It was later revealed to be salivary amylase. An endoscopy had revealed esophagitis and he was taking a proton pump inhibitor. When I went to the emergency department, he was not on his stretcher – his nurse told me that he was in the shower. As I approached, I could hear loud retching. I found the patient huddled on the shower room floor, shrouded in steam, with the hot water beating down on his back. Twenty-four hours later, after intravenous fluids, morphine and metoclopramide, he left against medical advice.

Some time later, in my routine trolling through the table of contents of Gut, I stumbled on ‘Cannabinoid hyperemesis: Cyclical hyperemesis in association with chronic cannabis abuse’ by Allen et al (1) – Eureka!

Since then, I have seen several more cases of CHS and have collected the published reports (2–15). There are 26 cases currently described in the literature I read.

The classic features of CHS are the following:

Chronic, heavy use of cannabis;
Recurrent episodes of severe nausea and intractable vomiting;
Abdominal pain;
Temporary relief of symptoms by taking a hot bath or shower; and
Resolution of the problem when cannabis use is stopped.
Undoubtedly, there are lesser versions of the syndrome, and a case missing features 3 and 4 has been described (6). There may also be other symptoms that we have yet to recognize.

It is important to recognize CHS because it may be misdiagnosed as psychogenic vomiting, the cyclic vomiting syndrome, an eating disorder or ‘drug seeking behaviour’, and may lead to extensive, expensive and unproductive investigations, psychiatric referrals and ineffective treatments. The details of the syndrome follow.

Most patients are daily and very heavy users of cannabis and have been doing so for years, often decades, before the vomiting episodes begin. The shortest reported length of use before the onset of symptoms is 18 months (9). The patient may not volunteer that they use cannabis – I have found that asking, “Have you tried marijuana for the vomiting?” is an easy way to approach the topic.

The vomiting episodes are cyclical, occurring every few weeks or months. They may be preceded by a period of intense morning nausea. I’ve seen two patients who had old food with the first emesis. The vomiting becomes bilious and culminates in intractable retching or ‘dry heaves’, which may last for hours. Most episodes resolve in 24 h to 48 h, but some may last several days.

The abdominal pain has often been described as epigastric and colicky. It may be diffuse. It may be constant. There may be a component of abdominal wall pain from the force of retching.

The temporary relief of symptoms with an extremely hot bath or shower is a learned behaviour; consequently, it may not be present at the initial presentation. However, once it develops, we are not talking about a routine bath or shower. Baths and showers may last for hours and be repeated up to 20 times per day. One wife said that her husband spent 300 of 365 days in the bath (7). The water-heating bill may become enormous. I’ve seen one patient whose gas bill was several hundred dollars a month. The patient may check into a motel or finally come to the hospital when they have exhausted the hot water supply at home. The patient may not volunteer that they take a hot bath or shower so, “Ever try a hot bath or shower?” is now part of my routine questioning when I see a patient with otherwise unexplained nausea or vomiting.

On examination, the patient is very distressed and retching repeatedly. It may be near impossible to get them out of the shower. They may appear anxious or agitated, with sweating, tachycardia and postural hypotension. They are often continuously sipping water. Abdominal wall pain with a positive Carnett’s sign may be present (16). There may be a low-grade fever if they have recently been bathing.

On investigation, urine will be positive for cannabinoids. There is often a mild leukocytosis. Elevated urea, hypokalemia, hypochloremia and alkalosis may occur. Endoscopy may reveal esophagitis and gastric mucosal trauma from retching. The latter is occasionally mistakenly labelled as ‘gastritis’. If performed early, there may be delayed gastric emptying (1,3,10).

Acute treatment consists of fluid and electrolyte replacement. It is uncertain whether any of the antinauseant, antiemetic, analgesic, antisecretory, prokinetic or sedative medications really help. Smoking marijuana during an episode appears not to help (1,8). Roelofs et al (17) suggested large doses of risperidone.

Chronically, the only therapy reported to be of benefit is cessation of cannabis use. How quickly it helps is uncertain but my impression is that once the patient leaves the emergency department, they will not return if they stop using cannabis. However, symptoms return within weeks if cannabis use is restarted.

The only problem I have with cannabis is I think I'm allergic to it. When I'm trimming or watering in short sleeves sometimes I will start to itch. I usually get around that by wearing long sleeves and gloves when handling the plants.

Other than that no issues from using cannabis, especially nothing as severe as this here. Holy hell that would suck, vomiting from smoking weed? Yikes!

i fuckin cough , puke , almost shit myself after i dab , lol but not this bad , i do get some dry heave sometimes too.its fuckin smoke going in our bodies , of course we will cough and shart ourselves sometimes.

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Had these exact same symptoms almost 3 years ago, coupled with all over muscle tension and back pain at injury sites.

Only thing I changed before I had the problem was the addition of Azadirachtin products to my grow. Azamax & Azatrol... Aza-Sol is another one that also uses azadirachtin as an active ingredient.

I grow clean... GH nutes with pH up, maybe a bit of pro-tekt once in a while. I use GH Bloom or Kool Bloom as a bloom booster. Nothing grown this way for 8 years ever 'messed' with me.

Moved to Colorado 3 years ago and started using azamax and azatrol. Went to the hospital by ambulance TWICE with these same symptoms after harvest.

Problems went away when I switched to Non-Azadirachtin cannabis. (Can't even use the shit in veg!$*$*#)

Tried it again about a year later and had the exact same issues.

AZADIRACHTIN (or the damn carrier oil that's used) is NOT compatible with cannabis. Period! I'm still waiting for the rest of the world to realize this in about 8 years or so. *facepalm*

By the way... stomach relief can be found by drinking home-made honey mead, eating garlic pan-fried in olive oil and eating a home-made fermented food that's correct for your blood type. (Usually kimchee, kefir or yogurt)

The garlic is a powerful anti-bacteria and the fermented foods put the beneficial enzymes and yeasts back in. That right side stomach/intestine pain is gas bubbles in your intestines.

Yeah... I lived in a hot bath for about 6 months and can converse with anyone intimately about this subject. I'm predicting a HUGE surge in ER and doctor visits in colorado come Jan 1st because most of the dispensary meds I've come across are just putrid with aza-products. :(

Wrote a couple articles on it already... check my sig as they're on my blog.

Type Cannabinoid Hyperemesis into Google or Bing and see just how many people have been diagnosed with this.

There are many other "Cannabis forums" with people reporting these symptoms as well.
It is a relatively new diagnosis, doctors didn't know what it was until it was reported in medical journals recently.

Just because you don't have it doesn't mean other people can't have it.

OBJECTIVE:
To promote wider recognition and further understanding of cannabinoid hyperemesis (CH).

PATIENTS AND METHODS:
We constructed a case series, the largest to date, of patients diagnosed with CH at our institution. Inclusion criteria were determined by reviewing all PubMed indexed journals with case reports and case series on CH. The institution's electronic medical record was searched from January 1, 2005, through June 15, 2010. Patients were included if there was a history of recurrent vomiting with no other explanation for symptoms and if cannabis use preceded symptom onset. Of 1571 patients identified, 98 patients (6%) met inclusion criteria.

RESULTS:
All 98 patients were younger than 50 years of age. Among the 37 patients in whom duration of cannabis use was available, most (25 [68%]) reported using cannabis for more than 2 years before symptom onset, and 71 of 75 patients (95%) in whom frequency of use was available used cannabis more than once weekly. Eighty-four patients (86%) reported abdominal pain with cyclic vomiting. The effect of hot water bathing was documented in 57 patients (58%), and 52 (91%) of these patients reported relief of symptoms with hot showers or baths. Follow-up was available in only 10 patients (10%). Of those 10, 7 (70%) stopped using cannabis and 6 of these 7 (86%) noted complete resolution of their symptoms.

Oh I believe it alright... people are ingesting massive amounts of THC without any CBD to counteract it.

Not surprised there's issues.

Just saying that Azadirachtin poisoning also produces the exact same symptoms.

Thank you Prohibition... (see my sig)

Keep it Clean!

Quote:

Originally Posted by Thomas Paine

Believe it, it is very real.

Type Cannabinoid Hyperemesis into Google or Bing and see just how many people have been diagnosed with this.

There are many other "Cannabis forums" with people reporting these symptoms as well.
It is a relatively new diagnosis, doctors didn't know what it was until it was reported in medical journals recently.

Just because you don't have it doesn't mean other people can't have it.

OBJECTIVE:
To promote wider recognition and further understanding of cannabinoid hyperemesis (CH).

PATIENTS AND METHODS:
We constructed a case series, the largest to date, of patients diagnosed with CH at our institution. Inclusion criteria were determined by reviewing all PubMed indexed journals with case reports and case series on CH. The institution's electronic medical record was searched from January 1, 2005, through June 15, 2010. Patients were included if there was a history of recurrent vomiting with no other explanation for symptoms and if cannabis use preceded symptom onset. Of 1571 patients identified, 98 patients (6%) met inclusion criteria.

RESULTS:
All 98 patients were younger than 50 years of age. Among the 37 patients in whom duration of cannabis use was available, most (25 [68%]) reported using cannabis for more than 2 years before symptom onset, and 71 of 75 patients (95%) in whom frequency of use was available used cannabis more than once weekly. Eighty-four patients (86%) reported abdominal pain with cyclic vomiting. The effect of hot water bathing was documented in 57 patients (58%), and 52 (91%) of these patients reported relief of symptoms with hot showers or baths. Follow-up was available in only 10 patients (10%). Of those 10, 7 (70%) stopped using cannabis and 6 of these 7 (86%) noted complete resolution of their symptoms.

I have suffered cannabinoid hyperemises. The people who don't think its possible just aren't consuming enough cannabinoids, or maybe they're less sensitive. It only happens when I'm consuming upwards of 3-4oz a month of 20%+ buds, or maybe I'm eating a lot of medibles in addition to my normal 2-3oz a month of bud consumption.

When I first started smoking... I would take too big of a hit and cough my head off. Now I take too big of a hit, and I have to run to the bathroom and puke. It could be my first smoke of the day, or later in the day. Doesn't matter. It has to do with plasma levels.